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Using less salt in your food may seem boring, but the payoffs could be as big as a lowered risk of death, new research has found.

Using a salt substitute when cooking was linked with a lower risk of dying early from any cause or from cardiovascular disease in a new study published Monday in the journal Annals of Internal Medicine.

“We are excited to be able to provide evidence that salt substitutions are effective for improving cardiovascular outcomes when used long-term, up to 10 years,” said the study’s senior author Dr. Loai Albarqouni, an assistant professor at the Institute for Evidence-Based Healthcare at Bond University.

“Previous synthesis tended to focus on short-term outcomes, lasting only two weeks.”

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The study is a systematic review of 16 randomized controlled trials that were published before August 23, 2023, and totaled 35,251 participants who were around age 64 on average and had a higher-than-average risk for cardiovascular disease. The trials were mainly in China, with the rest in the United Kingdom, Taiwan, Peru, the Netherlands and Norway.

With two-thirds of the findings coming from China, the authors “were surprised at how little salt substitution research has been conducted outside Asian countries,” Albarqouni said.

“This is partially why we have graded the evidence as ‘low to very low certainty’ for Western populations — there simply isn’t enough evidence to verify that salt substitutes would be as effective in the Western context.”

Salt substitution was also linked with a reduction in sodium in urine, and in blood pressure, an effect similar to that of blood pressure medications, the authors found. That could explain the lowered risk of death, Albarqouni said.

The authors acknowledged that in the trials, some of the salt substitutes were not verified and some were purchased by the participants instead of given to them by researchers.

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The trials compared the use of common salt — made of about 100% sodium chloride, occasionally with added iodine — with using a salt substitute comprised of 25% to 30% potassium chloride and 60% to 75% sodium chloride.

Another reason why applying the findings to a Western context is difficult is that salt consumption patterns in North America are “driven by processed and takeaway food, while consumption in the research context is more driven by the high amount of salt added during home food preparation,” Albarqouni said.

“This is not the strongest study to base a lot of conclusions on at this point,” said Dr. Andrew Freeman, a preventative cardiologist and director of cardiovascular prevention and wellness at National Jewish Health in Denver. “But it adds to the body of evidence and the signal in the noise that getting rid of sodium salt in your diet is a big plus and getting potassium in your diet is better,”

And “while we know potassium is beneficial, salt is salt,” Freeman, who wasn’t involved in the study, added. “If it’s sodium chloride or potassium chloride or magnesium chloride, it’s all salt. And the best way to get potassium in your body is to eat fruits and vegetables — that’s where potassium is most plentiful.”

Lowering your salt intake

The American Heart Association’s ideal daily sodium limit is 1,500 milligrams per day for most adults, especially those with high blood pressure, and no more than 2,300 milligrams daily.

“If the majority of your food intake is coming from packaged or restaurant food, chances are your sodium intake is too high,” Albarqouni said via email. “There are a few physical signs you may be eating too much sodium, like bloating or swelling, tiredness, high blood pressure, increased thirst and/or urination.”

If you’re concerned about your intake, you can seek medical or nutrition advice from a professional, Albarqouni added.

When buying packaged food, check the sodium content on labels. Some foods can contain more sodium than you think, such as poultry or cereals, Freeman said. One standard-size pickle typically has around 1,500 milligrams of salt, he added.

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Besides lowering salt consumption by simply eliminating salt in your home cooking, you can also try purchasing salt substitutes with a composition like the ones used in the study or using salt-free seasonings to add more flavor to food instead, experts said.

The authors acknowledged that more research is needed to confirm whether salt substitution of the study’s kind is safe for patients “sensitive to micronutrient manipulation,” including those sensitive to potassium — such as people with renal deficiency, they said.

Food with less salt may taste boring at first, but your tastebuds can adjust within just a couple of weeks, Freeman said, so give yourself time to adjust.

“It’s also important to remember that reducing sodium intake is just one way to reduce cardiovascular risk without medication,” Albarqouni said. “Things like diet changes, stopping smoking and increasing movement can also have an impact. Salt substitutes are not a holy grail to eliminating cardiovascular disease, but are one piece of the puzzle that can help.”

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With dieting, the conventional wisdom says a person needs to be in calorie-deficit mode to lose weight.

If you eat more calories than you burn, you gain weight; if you eat fewer calories, you lose weight.

But is that view really right? Doesn’t the kind of food you consume (keto, low-fat, vegan, etc.) and how often you eat (time-restricted eating versus six small meals) matter, too?

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Many studies have shown the conventional wisdom — calories in/calories out — is mostly true.

“It is not the only thing, but it is the main thing. And it’s mostly diet, not exercise, because exercising makes you hungrier and you eat more calories,” Christopher Gardner, the Rehnborg Farquhar professor of medicine at Stanford University, told CNN Chief Medical Correspondent Dr. Sanjay Gupta on the podcast Chasing Life recently.

Gardner, who is also the director of nutrition studies at the Stanford Prevention Research Center, has spent decades studying nutrition and food patterns.

He was the senior author of a November 2023 study published in the journal JAMA that looked at the cardiometabolic effects of a healthy omnivorous diet versus a healthy vegan diet in identical twins, which was made into the 2024 Netflix limited series You Are What You Eat: A Twin Experiment.

Gardner said a very methodical and comprehensive analysis of approximately 20 different diets was published jointly by the American Heart Association, the American College of Cardiology and the Obesity Society in 2013.

“And at the end of the day, they said, bottom line is on every one of these diets, people lose weight when there’s a calorie deficit. That was one of the main conclusions, and it was sort of as simple as that.”

But Gardner will be the first to say that there are many important nuances — such as the calorie deficit needed to lose a pound only grows as time on a diet progresses.

“People’s bodies react to that (deficit), and they become more metabolically efficient,” he said. That’s why people’s weight loss starts to plateau.

“So the longer you do this and the more weight you lose, the more discouraging it becomes, because it actually takes more effort to lose the next pound, which is psychologically demoralising for some people.”

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There’s another nuance to diets (based on his own research and that of others): Within each type of diet — keto, vegan, low-fat, etc. — some people will lose weight, and others will gain.

“The difference between the diets was just a few pounds. But the difference within each diet was 60 pounds (about 27 kilos),” he said, discussing his 2017 DietFITS study, noting somebody gained 10 or 15 pounds (about 4-6 kilos) while another lost around 50 (about 22 kilos). “There’s this huge range of variation.”

So, what’s the secret to successful weight loss? According to Gardner, there are two aspects.

“So, kind of the key to this calorie deficit is it’s stopping your meal soon enough to not overeat and having a long enough space till the next meal, so you’re not making up for that calorie deficit in the next few hours,” he said.

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He said he now believes a large part of weight loss success comes down to satiation, noting that what leaves people full can vary greatly.

“I often ask people in some of my talks, ‘Would you be more full and for longer on steel-cut oats with nuts and berries or with cheesy eggs?’ … I often get half the audience saying one (thing) and half the audience saying the other.”

What can you do to maximize your changes of losing weight and keeping it off? Here are Gardner’s top five tips.

Cut back on low-quality carbs and added sugars

Wean yourself off what Gardner calls “crappy carbs.”

“For most people decreasing or eliminating as much added sugar and refined grains will be the biggest bang for your buck,” he said via email, adding that the average American tends to get more than 40 per cent of calories from low-quality carbs and sugars.

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But replace those carbs wisely

You can’t just eliminate all those calories from low-quality carbs without replacing at least some of them.

“Shift to adding foods rich in fiber,” Gardner said, listing items such as beans/legumes (which he thinks Americans don’t get enough of), vegetables, whole intact grains and fruits.

In addition to fiber, add “sources of unsaturated fat (such as) avocados, nuts, seeds, vegetable oils, fatty fish, whole fat yogurt.”

Stop before you’re stuffed

Practice mindful eating. Pay attention to what you are eating and how you are feeling.

“Experiment with satiety/satiation. Try the Hara Hachi Bu principle of eating until you are 80 percent full, then stopping,” Gardner recommended, referring to the Okinawan practice of putting down your fork when you are slightly full rather than completely full.

In essence, it’s an easy way of restricting calories because it allows your body and brain to register how much you have eaten.

(It takes a moment for your brain to get the message from your belly that you have eaten enough.)

Change your mindset

Your food choices must be sustainable over the long run whether you pick a diet low in fat, low in carbs or high in protein or choose to follow a Mediterranean, vegan, keto or Paleo diet.

“Don’t think of this as a ‘diet’ that you are going ‘on’ (and) that you will go ‘off’ when you are done,” Gardner said in an email.

“It needs to be a dietary approach you can follow FOREVER for the benefits to last.”

For that approach to work, he said, you need to feel satiated, not deprived and hungry all the time.

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Show yourself some compassion

Acknowledge it’s not easy to change eating habits to lose weight.

“Be kind to yourself and patient,” Gardner said.

“Most people struggle with this. If you beat yourself up psychologically, for setbacks it can be even harder the next time you make an effort.”

Find joy in what you eat

Gardner had one final bonus tip: “You need to find joy and pleasure with what you are eating,” he said. “Allow yourself that for long-term success.”

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